Memo: Legislative Update 2

MEMO

To: ANA Vermont Membership

From: ANA Vermont Government Affairs Committee

Date: February 21, 2023

RE: Legislative Update - 2

This legislative session has significant bills introduced relating to nursing practice. This memo will provide an
update on the ANA-Vermont’s advocacy for three bills to support its members, and comment on the U.S. Senate Committee on Health, Education, Labor & Pensions full committee hearing “Examining Health Care Workforce Shortages: Where Do We Go From Here?” that was held on February 16, 2023.

A. S.36 - An act relating to permitting an arrest without warrant for assaults and threats against health care workers and disorderly conduct at health care facilities.

There is continued support for S.36 and providing the health care workforce additional tools for addressing workplace violence. The Senate Judiciary Committee approved the bill with Senator Tanya Vyhovsky voting in opposition to the bill. The bill includes an amendment regarding HIPAA, to require health care providers to share necessary information with law enforcement officers as to individuals being medically cleared to be removed from the facilities. As previously noted, this bill will require other Vermont legislation to be reviewed as well as working with organizations to understand how best to operationalize this legislation in real-life situations that provide cross sections with EMTALA and other patient rights issues. The bill will now go to the Senate Health and Welfare Committee for their consideration before going to the full Senate.

B. H.171 - An act relating to adult protective services.

ANA-Vermont joined a Coalition of professional organizations including The Vermont Association of Hospitals and Health Systems, Vermont Health Care Association, Vermont Medical Society, VNAs of Vermont and the Vermont Association of Adult Days in providing comments and proposed changes to H.171 regarding mandatory reporting of abuse, neglect, and exploitation of vulnerable adults. The bill as drafted would expand the scope of reportable abuse and neglect from the current standard of purposeful or reckless mistreatment to also include negligence. Expanding mandatory reports to negligence would require reporting of unintentional mistakes by a caregiver such as a missed dose of medication, or a fall (1).” The Coalition’s concern is that H.171 as drafted would dramatically increase the exposure of caregivers, including nurses, to damaging reports and investigations by Adult Protective Services. Medical errors are already subject to review by numerous other regulatory agencies. The threat of placing individual care givers on the Abuse Registry for system related errors would be another factor in demoralizing the workforce. The Coalition has proposed more narrow language and emphasized the need for clarity in reporting.

C. Sec. 1. 13 V.S.A. § 6567 - An act relating to criminal immunity for good faith provision of health care.

Representative Mari Cordes proposed a bill that addresses the concern of nurses and health care providers after the ReDonda Vaught case. This legislation would provide health care providers with immunity from criminal prosecution for acts or omissions that are a part of the good faith provision of health care. Importantly, this bill covers the good faith actions of health care providers and would not cover a health care provider that acts intentionally to cause harm or death. The ANA-Vermont supports this legislation and its support of the nursing workforce.

D. U.S. Senate Committee on Health, Education, Labor & Pensions: “Examining Health Care Workforce
Shortages: Where Do We Go From Here?”

On Feburary 16, 2023 the U.S. Senate Committee on Health, Education, Labor & Pensions held a hearing on healthcare workforce shortages. Of considerable note, Sarah Szanton, RN, PhD, Dean of the Johns Hopkins School of Nursing served as a nursing workforce expert witness and Douglas O. Staiger, PhD from Dartmouth College, Department of Economics served as a data analyst related to nursing workforce.

Dr. Szanton described nursing as the “oxygen of the health care setting (2),” and the essential value of nursing.
Recognizing that the nation needs at least 250,000 additional nurses by 2025 and the average age of nurse is 54 years old, there are complex and challenging issues ahead for nursing and for health care. Approximately 90,000 qualified nursing school applicants are turned down each year due to the constraints of our educational system from lack of funding, lack of appropriate pay, and a lack of adequate tuition and loan repayment funding (2). Dr. Szanton recommended that the Committee support S.246 – Future Advancement of Academic Nursing (FAAN) Act, which would increase funding to nursing schools.

Dr. Staiger provided critical testimony on the nursing workforce from an economic standpoint. He noted that in
2021 approximately 100,000 nurses left the workforce, but in 2022 we rebounded and are tasked to be back on
track to pre-pandemic projections (3). He testified that there are three main concerns looking ahead for the nursing workforce that need to be addressed:

1. the shift of the nursing workforce away from the hospital;
2. the decreased academic preparedness of students entering, and exiting nursing schools; and
3. the need to diversify the rural workforce and increase bachelor’s degrees among rural nurses (3)

A key line of questioning that involved some back and forth between Dr. Szanton and Dr. Staiger was on the role of bachelor’s prepared nurses. A committee member noted that there was an apparent bias towards nurses that hold bachelor’s degrees. Dr. Szanton appropriately addressed the question by stating that bias is not the appropriate descriptor, and that there is a wealth of research that shows that organizations with a greater proportion of bachelor’s prepared nursing staff have improved patient outcomes. Dr. Staiger agreed by noting that in workforce development, you can educate a nurse through different programs and support their growth and development to achieving a bachelor’s degree, which systematically improves patient outcomes. This is a conversation that nursing has been having for decades, which due to the workforce shortage is now before the Senate Committee.

Overall the hearing was robust and there was evidence of innovative programs throughout the country. ANA-
Vermont will follow the national dialogue, and look to advocate for supportive health care workforce legislation at the national level to benefit Vermont nurses. You may watch the full recorded hearing at this link: Examining Health Care Workforce Shortage... | Senate Committee on Health, Education, Labor and Pensions

1 H.171~Jill Mazza Olson~ Comments by Health Care Provider Association Coalition~2-10-2023.pdf (vermont.gov)

2 Szanton5.pdf (senate.gov)

3 Staiger.pdf (senate.gov)